Abstract
INTRODUCTION: Growing evidence suggests that a persistent systemic inflammatory response is associated with poorer survival outcomes in patients with malignant disease. The modified Glasgow Prognostic Score (mGPS), based on elevated C-reactive protein (CRP >10 mg/L) and hypoalbuminemia (<35 g/L), has been established as an independent prognostic marker in various cancers. The aim of this study was to evaluate the prognostic value of the mGPS in patients with metastatic urothelial carcinoma of the bladder (mUC) receiving immunotherapy, with particular focus on treatment response, tolerability, and overall survival (OS). METHODS: In this retrospective single-center cohort study, 48 patients with mUC treated with immune checkpoint inhibitors were included. Patients received immunotherapy either due to ineligibility for platinum-based chemotherapy or as second-line treatment following disease progression. Pretreatment mGPS was categorized into 3 groups: mGPS 0 (CRP <10 mg/L), mGPS 1 (CRP >10 mg/L, albumin ≥35 g/L), and mGPS 2 (CRP >10 mg/L, albumin <35 g/L). OS and disease-free survival (DFS) were analyzed using the Kaplan-Meier estimates. Treatment-related toxicity was assessed according to Common Terminology Criteria for Adverse Event criteria. Prognostic factors were evaluated using univariate Cox regression analyses. RESULTS: Survival outcomes differed significantly across mGPS categories, with patients classified as mGPS 0 demonstrating the most favorable treatment response and survival. In univariate analysis, both mGPS (p < 0.0001) and tumor stage (p = 0.004) were significantly associated with prognosis. Response rates to immunotherapy varied markedly between groups (mGPS 0: 71%, mGPS 1: 34%, mGPS 2: 26%; p < 0.001). Higher mGPS values were also significantly associated with increased treatment-related and disease-related morbidity. CONCLUSION: Systemic inflammation and nutritional status, as reflected by the mGPS, are independent predictors of treatment response, toxicity, and survival in patients with mUC undergoing immunotherapy. Alongside established pathological markers, the mGPS represents an objective, low-cost, and readily available prognostic tool with potential clinical utility in routine practice.